Associations between geriatric assessment-identified impairments and financial distress in older adults with non-small cell lung cancer (NSCLC): Report from the UAB CARE and WeCARE registries.

31 Background: Reports of financial distress (FD) among older adults with cancer are limited. Geriatric assessments (GA) have been shown to identify impairments using patient-reported outcome data; we sought to identify GA identified impairments associated with FD among older adults with NSCLC. Methods: This was a retrospective study of patients aged ≥65 with NSCLC who completed a GA and were enrolled in the Cancer and Aging Resilience Evaluation (CARE) from 2018-2021 or Web-enabled CARE (WeCARE) from 2024-2025 registries at the University of Alabama at Birmingham. Examined GA domains included functional status, physical function, and health related quality of life (HRQOL) including both global physical and mental health. FD was assessed using a single-item question (“Do you have to pay for more medical care than you can afford?”) in the CARE cohort, and using a score ≤26 from the comprehensive score for Financial Toxicity (COST-FACIT) in the WeCARE cohort. The relationship between FD and GA impairments was assessed using odds ratios (OR) and 95% confidence intervals (CIs) from multivariable logistic regression models adjusted for patient age, sex, race, education and employment status. Results: Of 116 older adults with NSCLC who completed a CARE (n = 59) or WeCARE (n = 57) survey, median age was 71 years (range: 65-86), 61% were male, 79% were white, 38% had college or higher education, and 72% were disabled, retired, or unemployed. Overall, 34% of patients reported FD. Patients with higher odds of FD were African American (v White; OR = 3.11; 95% CI, 1.06 to 9.19), and had less than high school education (v a college or above degree; OR = 6.7; 95% CI, 1.43 to 33.3). Patients with higher odds of FD also reported GA impairments in physical function: ≥ one fall (v none; OR = 3.12, 95% CI 1.21-8.04), limitations in walking one block (v none; OR = 2.60, 95% CI 1.05-6.48; and impaired HRQOL in physical (OR = 2.39, 95% CI 1.03-5.53), and mental health (OR = 2.46, 95% CI 1.00-6.12). Conclusions: Almost a third of older adults with NSCLC reported FD at time of presentation to a medical oncologist visit. Sociodemographic factors, physical and mental health related impairments were associated with higher reporting of FD.With recent therapeutic developments in cancer care, cost of cancer care continues to rise thus proper allocation of resources is needed to manage FD in this vulnerable population.